Understanding the economics of Tuberculosis (TB) patients in the private sector

Background

Despite free treatment offered by the government, the private sector plays a significant role in Tuberculosis (TB) treatment in India. The reasons for availing private facilities are dissatisfaction with public sector services, non-availability of public facilities in the neighbourhood, long waiting time etc. A literature review identified that only three studies (covered total of 102 patients) estimated the cost for the TB patients treated in the private sector. Two studies considered only multi-drug resistant TB patients, the third one collected out of pocket expenses data from a convenient sample of 32 drug susceptible TB patients. Therefore, there is a clear dearth of data on the economic burden of TB in the private sector in India.

Aim

The national strategic plan for TB (2017-2025) stated its intention to extend the umbrella of high-quality TB care and control to those treated in the private sector, highlighting private sector engagement (PPE) as an important strategy to eliminate TB. The primary objective of this study is to determine exposure to any PPE strategy components:

Reduces out of pocket patient costs and incidence of catastrophic expenditure
Reduces delay to correct diagnosis and appropriate treatment
Improves medication adherence and treatment outcomes
Improves patient satisfaction and retention

Research Methodology

In this prospective cohort study, approximately 1250 adult pulmonary TB patients seeking treatment from private providers will be sampled from five districts of five states. Patients will be sampled through notifications from private providers and chemists of the sampled districts. Each patient will be interviewed thrice: at intake, 3 months and 6 months of treatment using TB patient cost survey instrument developed by the World Health Organization and adapted for the Indian context.